Diagnosis is an important stage in understanding the cause of your child’s seizures and determining whether your child has epilepsy. If your child has had a seizure, it does not necessarily mean that they have epilepsy. Seizures can occur for a variety of reasons, which your child’s health-care provider will explain to you. In addition, other conditions or behaviours may look like seizures but are not.
Diagnosing epilepsy will involve a detailed patient history, a physical and neurological exam and, possibly, several tests. There is no one test that can always identify epilepsy. Epilepsy is a clinical diagnosis. This is why a patient history and your observations of your child’s seizures are an essential part of diagnosis. Each meeting with your child’s health-care team during diagnosis is important but can be difficult emotionally. For these reasons, take notes and write questions as you think of them. You may also bring a relative or friend to take notes for you.
Medical history
The medical history includes your and your child’s description of their seizures – what they felt and what you observed before, during and after the seizures. You may wish to video-record your child’s seizures for the neurologist to see, as it may help identify your child's type of epilepsy.
The health-care provider will also ask questions about:
- your child’s health, eating habits and exercise
- their development up to now, how they are doing in school and whether any family members had seizures
- the parent's pregnancy in case health and experiences during pregnancy are connected with your child's seizures
- your child's birth history and any complications during their newborn period
If your child is older, the health-care provider will ask how active they are, about the symptom(s) that prompted the visit and past medical experiences and hospitalizations. The health-care provider will also ask about other aspects of your child’s life, such as how they are doing at school and whether they are having trouble keeping up.
Regardless of your child’s age, the health-care provider may also ask about:
- any siblings or other relatives who may have had epilepsy or seizures
- the details of your child’s birth
- your child’s development
- recent or past head injuries
- fever
- other illnesses or medical conditions
- medications your child is taking
- what your child experienced before, during and after the seizure.
The health-care provider will also ask for your observations before, during and after the seizure, including:
- the time of day
- what your child was doing before the seizure
- whether they were sick, tired, stressed or emotional or if they had fever
- how the seizure began
- what their movements (if any) looked like during the seizure
- if the movements were on a particular side of their body
- whether they were able to talk and respond during the seizure
- whether they made any sound
- how long the seizure lasted
- if they were confused, tired or sore after the seizure
- if they could speak normally after the seizure
- if they have had more than one seizure, whether the seizures looked the same each time
Physical examination
A physical examination of your child may be carried out by the health-care provider. They will ask specific questions about symptoms, as this can provide clues to your child's type of condition.
The health-care provider generally starts by examining your child's appearance, skin colour, general health, comfort level and behaviour, and measures their height, weight and head circumference. They may record your child's heart rate, breathing rate, body temperature and blood pressure.
The health-care provider will use a stethoscope to listen to your child’s heart and their lungs for problems. They will look for general physical abnormalities and certain birthmarks.
Neurological examination
The health-care provider will perform a neurological examination as part of the physical examination. A neurological examination tests your child’s brain and nervous system. This will help to find out which part of your child’s brain is affected and causing symptoms.
A relevant neurological exam will also be done. Here are some examples of tests that might be done, depending on your child’s age and level of development.
- Mental status: Your child may be asked the time, the day of the week and the date. They may be asked to repeat a list of objects, describe yesterday’s breakfast and talk about a recent holiday or family gathering. Their level of attention to the person conducting the test will be observed.
- Cranial nerve functions: Your child may be asked to follow an object with their eyes, to see how well they move. They may be asked to smile, turn their head, shrug their shoulders, stick their tongue out and open and close their eyes.
- Motor function: To test muscle strength, your child may be asked to grip the examiner’s hand. They may have to hold their arms straight out for 10 seconds with their eyes closed. The examiner may hold their arms and legs and ask them to push.
- Reflexes: The examiner may test your child’s arm, leg and foot reflexes by gently tapping on them with a rubber hammer.
- Coordination and gait (how your child walks): Your child may be asked to walk on their toes, balance on one foot and balance with their feet together and their eyes closed. They may be asked to touch their fingers to their nose and then to the examiner’s finger.
- Sensory function: Your child’s sense of touch may be tested using various objects such as a tongue depressor or cotton ball.
Diagnostic tests
If the results of the physical and neurological exams suggest that your child may have epilepsy or a physical problem that is causing seizures, additional tests may be scheduled. These tests may include:
- an EEG
- brain imaging tests, such as an MRI scan
- genetic testing (this may be done in some children to determine if epilepsy is caused by a gene mutation)
For some of these tests, your child will need sedation. You will be told about the test before your child has it, along with certain things you will need to do to help prepare your child for the test.
Will my child need to have a lot of tests?
Usually, children with epilepsy need an EEG and an MRI. Other tests may be needed if your child has drug-resistant epilepsy or other brain problems along with epilepsy.
How can I help my child get through tests?
The health-care providers who will be giving your child tests are very skilled at what they do and skilled at working with children. They will be as gentle and efficient as possible. They will take account of your child's age and experiences and adjust their approach accordingly. If a procedure is expected to cause pain, such as a lumbar puncture (spinal tap), or if your child must stay very still for a test and is unable to do so, they will be given a sedative or an anesthetic.